胶质瘤中MGMT和P53蛋白表达与临床病理的关系

目的初步探讨脑胶质瘤中MGMT、P53蛋白表达与胶质瘤临床病理的关系。方法免疫组织化学（Envision两步法）检测49例脑胶质瘤中MGMT蛋白表达及硝3蛋白表达。结果49例脑胶质瘤MGMT蛋白表达阳性率为55．10％（27／49）。脑胶质瘤病理分级Ⅱ、Ⅲ、Ⅳ级MGMT蛋白表达阳性率分别为59．09％、50．0％、45．45％,各组间差异无统计学意义（P=0．754）,MGMT蛋白表达在男性为59．26％,女性为50．0％,两者之间差异无统计学意义（P=0．517）;MGMT蛋白表达在〉50岁患者中为53．84％,≤50岁患者中为61．11％,两者之间差异无统计学意义（P=0．915）。27例MGMT蛋白表达阳性的组织中7例P53蛋白表达阳性;22例MGMT蛋白表达阴性的组织中12例P53蛋白表达阳性,胶质瘤组织MGMT与P53的表达呈负相关（r=-0．292,P〈0．05）。结论MGMT蛋白表达可能与脑胶质瘤发生和预测放化疗敏感性有关,而与胶质瘤病理分级和临床特征无显著关系。     

神经胶质瘤中SPARC、P53和VEGF的表达及临床意义

目的 通过检测富含半胱氨酸的酸性分泌蛋白(SPARC)、P53和血管内皮细胞生长因子(VEGF)在神经胶质瘤中的表达,探讨三者之间的相关性及其临床意义. 方法 依据神经胶质瘤的分级选取神经胶质瘤患者90例和瘤旁脑组织30例,采用免疫组织化学方法检测SPARC、P53和VEGF在神经胶质瘤不同病理分级中的表达情况,进行临床病理相关性分析.结果 ①在胶质瘤中VEGF、P53的阳性表达率分别是75.56％和68.89％,均显著高于瘤旁脑组织中的阳性表达率(20.00％和0),而SPARC的阳性表达率在胶质瘤低于瘤旁组织(24.44％ vs 80.00％,P＜0.01).②SPARC的阳性表达率随着胶质瘤恶性程度的增高而降低(P＜0.05);且阳性和阴性患者生存率分析差异无统计学意义.③VEGF的阳性表达率随着胶质瘤恶性程度的增高而增高(P＜0.01),其阳性和阴性患者生存率差异有统计学意义.④P53的阳性表达率与肿瘤病理分级中差异无统计学意义;其阳性和阴性患者生存率差异有统计学意义.⑤在神经胶质瘤组织中,P53和VEGF的表达呈正相关,SPARC与P53、VEGF的表达均呈负相关. 结论 ①SPARC在神经胶质瘤中的阳性表达率显著低于瘤旁脑组织.②SPARC表达下调和P53、VEGF表达上调与神经胶质瘤的发生、发展及预后有关.     

肾透明细胞癌中Survivin表达及其与bel-2和p53的相关性研究

目的探讨Survivin蛋白、bcl-2蛋白、p53蛋白在肾透明细胞癌（RCCC）组织中的表达及意义。方法应用免疫组织化学S-P法检测Survivin、bel-2、p53在53例RCCC和12例正常对照的表达，计算阳性细胞百分率，并进行组间比较。结果Survivin在RCCC组织中阳性表达率为77、4％，高于正常肾组织的阳性率（0），P〈0．01。不同病理分级及临床分期比较Survivin表达差异有统计学意义，P〈0．05。bcl-2在RCCC组织表达阳性率为66％，正常肾组织中16．7％，差异有统计学意义，P〈0．01。p53在RCCC组织中阳性率39．6％，高于正常肾组织的0，P〈0．01。不同病理分级及临床分期之间bcl-2和p53表达差异均无统计学意义。Survivin表达阳性和阴性者bcl-2阳性率分别为73．2％和41．7％，P〉0．05。Survivin表达阳性和阴性者p53阳性率分别为41．5％和33．3％，P〈0．05。结论Survivin蛋白在RCCC肿瘤细胞中表达升高，与RCCC病理分级、临床分期密切相关，有可能作为判断病情和评价预后的指标；bcl-2及p53蛋白在RCCC肿瘤细胞中表达升高，与RCCC病理分级、临床分期无明显相关性。Survivin蛋白的表达与bcl-2蛋白的表达无明显相关性；与p53蛋白的表达明显相关，两者在RCCC的发生发展中可能存在协同作用。     

眼部肿瘤组织中血管内皮生长因子的表达和微血管计数的研究

目的：探讨肿瘤组织内的血管内皮生长因子(vascular endothlial growth factor,VEGF)的表达和微血管计数(microvessel counts,MVC)与眼部良恶性肿瘤的关系。方法:采用免疫组化技术检测40例眼部肿瘤(良性肿瘤22例，恶性肿瘤18例)组织内的VEGF的表达和MVC。结果:18例眼部恶性肿瘤组织中16例VEGF表达阳性(16／18，89％)，22例良性肿瘤中VEGF仅3例阳性表达(3／22，13％)，两者比较差异有非常显著性(P＜0．01)；恶性肿瘤组织MVC较良性肿瘤明显增高(P＜0．01)。MVC与VEGF的表达呈正相关(r=0．41，P＜0．05)。结论：眼部肿瘤组织内的VEGF表达和MVC的高低可能与肿瘤内的血管生成和良恶性有密切关系。     

VEGF和p53蛋白在上皮性卵巢肿瘤中的表达及意义

目的：探讨上皮性卵巢肿瘤组织中血管内皮生长因子（VEGF）及p53蛋白的表达及临床病理意义。方法：用SP免疫组织化学方法检测VEGF和p53蛋白在卵巢上皮性肿瘤组织中的表达，结果：恶性、交界性及良性卵巢肿瘤组织中VEGF阳性表达率分别为35．3％、60．4％、72．4％，VEGF表达率在恶性肿瘤和交界性肿瘤较良好性肿瘤明显增高，且与卵巢癌淋巴结转移有关（P＜0．05），而与病理学分级，临床分期无关；p53蛋白表达与VEGF表达呈明显正相关（P＜0．05）。结论：VEGF在卵巢上皮性肿瘤的发展中起着重要作用，突变型p53蛋白可能与卵巢肿瘤的血管生成调节。     

脑胶质瘤中p53抑癌基因蛋白表达的研究

目的：观察不同类型胶质瘤中p53抑癌基因蛋白的表达及其意义。方法：应用LSAB免疫组织化学技术对50例不同类型脑胶质瘤中石蜡组织中p53蛋白的表达进行研究。结果：18例胶质瘤中呈现p53蛋白表达，阳性率为36％，并随星形细胞瘤的恶性程度而升高（P＜0．05）。其中星形细胞瘤Ⅰ级p53蛋白阳性表达率为0，Ⅱ级阳性率为27．2％，Ⅲ级为47．1％，Ⅳ级为77．8％，四级间的阳性率有显著差异，结论：p53蛋白的表达与胶质瘤的病理类型，恶性程度相关，因此检测该基因的表达情况，对胶质瘤生物性行为的判断及预后的估价具有积极的参考价值。     

CD44v6、v9和P53蛋白在人喉癌中的表达及与预后的关系

目的：探讨CD44v6、v9和P53蛋白联合表达在人喉癌发生、发展及预后中的作用。方法：采用免疫组织化学EnVi—sion法检测223例喉不同病变组织标本(喉癌143例，喉癌前病变32例，声带息肉39例和癌周正常喉组织9例)中CD44v6、v9和P53蛋白的表达。结果：(1)CD44v6、v9和P53在人喉癌组织中表达阳性率分别为72．7％(104／143)、56．6％(81／143)和52．4％(75／143)；喉癌前病变组织中为37．5％(12／32)、31．3(10／32)％和21．9％(7／32)；声带息肉中为17．9％(7／39)、12．8％(5／39)和10．3％(4／39)；癌周正常喉组织中均为0(0／9)；3种蛋白在喉癌组织中阳性表达率均显著高于癌前病变及声带息肉组织(P＜0．01)。(2)CD44v6、v9和P53在人喉癌组织中联合表达阳性率为41．3％(59／143)，显著高于其他喉不同病变组织中联合表达阳性率(8．8％，7／80，P＜0．01)。(3)CD44v6、v9和P53在Ⅰ—Ⅱ期喉癌组织中表达阳性率分别为56．5％(35／62)、40．3％(25／62)和38．7％(24／62)，均显著低于Ⅲ—Ⅳ期喉癌组织[分别为85．2％(69／81)、69．1％(56／81)和62．9％(51／81)，P＜o．011。(4)CD44v6、v9和P53在伴颈淋巴结转移的喉癌组中表达阳性率分别为85．7％(36／42)、78．6％(33／42)和73．8％(31／42)，均显著高于无颈淋巴结转移组[分别为67．3％(68／101)、47．5％(48／101)和43．6％(44／101)，P＜0．01]。结论：CD44v6、v9和P53联合表达与人喉癌的发生、发展及预后有一定的相关性。     

脑星形细胞瘤组织中VEGF、iNOS蛋白的表达及其意义

目的探讨血管内皮生长因子（VEGF）、诱导性一氧化氮合成酶（iNOS）蛋白在脑星形细胞瘤中的表达及其意义。方法采用SP免疫组织化学法，检测VEGF、iNOS蛋白在59例不同病理分级脑星形细胞瘤组织中的表达情况。结果VEGF、iNOS蛋白表达的阳性率分别为76.2％（45／59）、71.2％（42／59），VEGF与病理分级密切相关（P〈0．05）；VEGF、iNOS均与肿瘤单位视野中血管平均值（MVD）密切相关（P〈0．05）。VEGF、iNOS的表达存在相关性。结论VEGF表达与脑星形细胞瘤的发生发展及肿瘤性血管的生成存在密切的相关性；iNOS通过协同和促进VEGF的表达及肿瘤性血管的生成，间接参与肿瘤细胞的恶性演化。     

抑癌因子PTEN和血管内皮生长因子在大肠癌的表达

目的探讨抑癌因子PTEN和血管内皮生长因子（VEGF）蛋白在大肠癌中表达的意义。方法采用免疫组化SP法检测48例大肠癌患者PTEN和VEGF蛋白的表达,探讨其与大肠癌临床病理特征及生物学行为的关系。结果大肠癌中PTEN蛋白表达阳性率为45．8％（22／48）,明显低于正常大肠黏膜组织（P〈0．01）;VEGF蛋白表达阳性率为72．9％（35／48）,明显高于正常大肠黏膜组织的阳性率（P〈0．01）;PTEN和VEGF蛋白表达呈负相关（P〈0．01）;PTEN低表达和VEGF高表达与大肠癌Dukes分期、浆膜浸润、淋巴结转移有关（均P〈0．01）,而与年龄和组织学类型无关（P〉0．05）。结论PTEN和VEGF表达与大肠癌临床病理特征和生物学行为密切相关,联合检测FFEN和VEGF蛋白的表达,对大肠癌的恶性程度及预后判断具有重要的临床意义。     

p16 CyclinD1 C-erbB2在乳腺癌中的表达及临床意义

目的：探讨乳腺癌组织分型、分级等临床病理特征和ER、PR与p16、CyclinD1、C-erbB2蛋白表达的关系。方法：进行免疫组化S-P染色法，检测58例术前均未做放、化疗的乳腺癌组织中p16、CyclinD1、C-erbB2蛋白的表达。结果：p16蛋白表达阳性率为67．24％(39／58)，在乳腺癌Ⅱ级与Ⅲ级之间p16蛋白阳性率分别为76．7％(23／30)和33．33％(4／12)，差异有显著性(P＜0．05)；原发癌伴淋巴结转移组p16的阳性表达率55．17％(16／29)，低于不伴淋巴结转移组p16的阳性率79．32％(23／29)，差异有显著性(P＜0．05)，p16表达与肿瘤大小、ER、PR无相关性。CyclinD1蛋白表达阳性为63．79％(37／58)，乳腺癌Ⅱ、Ⅲ级之间CyclinD1蛋白表达差异有显著性(P＜0．015)；CyclinD1与病理分型、肿瘤大小、淋巴结转移、PR未见相关，与ER正相关。C-erbB2蛋白表达阳性率37．92％(22／58)，C-erbB2癌基因表达与腋淋巴结转移和乳腺癌组织分级相关(P＜0．01)，与ER、PR肿瘤大小、分型无相关。结论：①p16、CyclinD1、C—erbB2基因蛋白异常与乳腺癌发生有关；②p16、C—erbB2与淋巴结转移有关；③p16、CyclinD，、C-erbB2蛋白可作为判断乳腺癌预后的参数；④p16、cyclinD1、C-erbB2无相关，各自发挥作用。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.